Department of cardiac muscle pathology and transplantation of organs and tissues

Thromboembolism

Thromboembolism of the pulmonary artery: causes, symptoms, diagnosis and treatment.

Thromboembolism of the pulmonary artery (TEPA) is a pathological condition caused by the entry of the one or more thrombi (emboli) into the pulmonary artery system. Closing of the lumen of the latter starts a series of pathological reactions (disorders circulatory system, gas exchange, shock), which can lead to death.

Etiology

The main cause of TEPA is the detachment of floating thrombus from the veins of the lower, rarely upper limbs, small pelvic organs, kidneys, the right atrium and blockage of one or more branches of the pulmonary artery by them.In most cases, the source of thrombi is varicose veins of the lower limbs with formed blood clots.Phlebothrombosis is a direct threat to the development of TEPA.Pathogenetically, the Virchow's triad contributes the thrombus formation:

3) damage of the vascular wall endothelium (damage of the vessels during injuries, surgeries, manipulations, affection of the vessel intima by poisons, toxins, antibodies, etc.)

The load with a sharp increase in intravascular pressure (lifting of heavy things, straining effort, leaping) can lead to sudden thrombus detachment and development of TEPA.The risk group includes people over 65 years old, with hereditary tainted, varicosity, phlebotrombosis or TEPA in a history, atrial fibrillation.

Clinic

The clinic of TEPA is not specific and is manifested in the form of shortness of breath, pain in the chest, a decrease in blood pressure, cough (sometimes with blood spitting), cyanosis of the face, clouding of consciousness. A few hours later, there comes an easy gait that accompanies the blood supply of the occluded branch. Within 2-4 days, a pneumonia with a characteristic clinic and nonspecific inflammatory changes develops in the affected area. Embolism of small branches can be asymptomatic, and massive one can cause shock and death.

Diagnostics

X-ray study of thoracic organs, angiopulmonography;

ECG, echocardiography;

Laboratory diagnostics (D-dimer - allows to exclude pathology);

Multislice spiral CT with contrast enhancement;

Perfusion lung scintigraphy.

Treatment

The basis of treatment is conservative therapy. Direct and indirect anticoagulants, drugs for thrombolysis therapy are used. Surgical treatment in the form of thrombectomy is used with ineffectiveness of conservative treatment and augmentation of heart failure occurrence. Cava filters are used for people with a greatly increased risk of TEPA.